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General NPI Number Information
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NPI Number | 1790113751
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Entity Type | Individual
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Provider Name | JENNIFER WATERS LMP
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Gender | Female
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Dates
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Enumeration Date | 10/29/2013
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Last Update Date | 10/29/2013
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Provider Practice Location Address
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Address Line | 711 ST HELENS AVE
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City | TACOMA
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State | WA
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Zip | 98402-3722
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Country | US
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Telephone | 253-426-3313
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Fax |
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Provider Business Mailing Address
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Address Line | 20306 50TH AVE E
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City | SPANAWAY
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State | WA
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Zip | 98387-4776
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Country | US
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Telephone | 775-934-3939
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA6031191
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License Number State | WA
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